Internal Medicine

I thought I might start a thread about internal medicine residencies, in the same vein as Tec and MPP’s threads, if there is any interest, just because, statistically, there are probably a lot of people on the board going into IM. I suspect the experiences during this year aren’t too different from what Tec is experiencing during prelim year, but there might be some.

Any interest?

Hell yeah! I am so stoked to see former pre-meds who are sufficiently invested in OPM to devote some of their precious free time to relay back to us their observations & experiences in the world of residency. This is something that we, the leadership corps of OPM, have endeavored to foster for a long time. I am also noticing this phenomenon in the med student forums too. This is totally AWESOME! Wish I had had the presence of mind to chronicle my journey more well…but, I was too occupied with OPM…at least that is my excuse

I am going to post a few of my observations about internship in internal medicine, for those who are thinking about going into it, or are just interested. Here goes.

This is my second month of internship, but my first month was an outpatient rotation where I essentially worked 7-5 or 6… and the hours were only that long because of the slowness of those initial dictations, learning the system, etc. It was a great month. I learned a lot about basic allergy treatments, and saw some unusal cases as well, such as mastocytosis (a disorder where the mast cells will release chemical mediators, particularly histamine) resulting in “spells” for the patient of high blood pressure, lightheadedness, flushing, and other odd and assorted symptoms. In the first month I also became proficient in the computer system and using it to order tests. It was a fun month.

And then came hospital wards… for all practical purposes, this was the first month of internship. At my institution we are on call Q4. We don’t have NF, but the seniors do. This is good, because they are, theoretically, somewhat rested, and hence willing and able to help the interns. My first day was a call day. I felt like a deer in the headlights. There was so much to learn and to try to absorb, while actually trying to manage patients as well. Fortunately, I have been on a great team. The senior residents are supportive and helpful, and have been very understanding that it was the interns first month. We were a little jinxed in that for some reason we got slammed and have capped on nearly all our call days. But I’ve learned a ton. I am much more confident already in making a decision and acting on it, rather than checking with the seniors for every little thing. I am really surprised at how well I can cope with being at work for 30 hours. The first morning after call, I felt so sleepy, and so mentally over whelmed that I didn’t feel functional. Now, I find I just keep going.

I really thought that 80 hours was more than enough to get things done. I have a feeling I’m going to hear about my hours, because my program is very strict about abiding by them, and while I’ve always gotten out by 30 hours, the 80 hour rule is much harder to make, because the census has been so high (and I have been so slow). I don’t know how many hours I’ve spent, but I suspect I’ve been well over most weeks.

I pronounced a death for the first time this week. It happened in the wee hours of the morning. I was called to the bedside of a DNR patient I was cross-covering, and knew well from my nights on call, and the nurses and I just stayed with her while she breathed her last. Then I had to call the family. I hate having to wake people up at 3 in the morning to tell them a family member died.

The worse day I’ve had so far was one on which I was slammed with a very difficult patient, not medically but with other issues, and somehow managed to lose both my PDA stylus (which I could manage without), and later in the day the memory chip. Since in two years of using a PDA I have never lost either how I managed to lose both within four hours is a real mystery. I have my trusty Tarascon and Sanfords, but I still felt handicapped.

So far, even though I’m chronically tired (although right now I’m actually feeling human, having had a few nights in a row of good sleep), and I’m generally in survival mode, I am still glad I chose this field, and I enjoy the work. I just wish I had more time to read and learn about the patients. I have two more weeks (August being a five week month), and then I’ll get to do another outpatient rotation.

Well, I’m on call again tomorrow, after a lovely day off, so I better go put my call bag together, and get some sleep.


Wow. That’s wild. I don’t think many people have an appreciation for how hard and long doctors of all specialties work. I’m just beginning to learn this myself. I’ve decided to remain neutral regarding my interest in specialties. There’s just so much out there, and I don’t want to prejudge anything.

Thanks so much for sharing this, though. I love to hear what goes on during medical school AND after.